# GRANGER MEDICAL CLINIC PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** GRANGER MEDICAL CLINIC PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1871320028
- **Legal business name:** GRANGER MEDICAL CLINIC PC
- **Authorized official:** MARY JANE PENNINGTON MD (PRESIDENT)
- **Authorized official phone:** (801) 965-3600

## Contact information

- **Practice address:** 9844 S 1300 E STE 100, SANDY, UT 84094-4600
- **Practice address phone:** (801) 965-3600
- **Mailing address:** 2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
- **Mailing address phone:** (801) 965-3505

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/19/2024
- **Last updated:** 09/19/2024